Provider Demographics
NPI:1215058896
Name:WEBER, KAREN DIANE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:DIANE
Last Name:WEBER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:CABALLO
Mailing Address - State:NM
Mailing Address - Zip Code:87931-0007
Mailing Address - Country:US
Mailing Address - Phone:505-743-3575
Mailing Address - Fax:505-743-3579
Practice Address - Street 1:180 N DATE ST
Practice Address - Street 2:
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901-2824
Practice Address - Country:US
Practice Address - Phone:505-894-8383
Practice Address - Fax:505-894-0606
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3009631041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM05256208Medicaid